Related topics: •  Chicken Pox (Children) •  Skin & Hair Problems

All that many people know about shingles is that it involves a painful rash. Many don't realize that the same herpes virus that leads to the common illness chicken pox also causes shingles. This virus is called "varicella zoster," so shingles is also known as "herpes zoster" or simply "zoster."

Anyone who has had chicken pox may develop shingles at some point in time. After a person has chicken pox, the virus remains in the body and stays dormant in nerve cells. For reasons that are not entirely understood, in some people these inactive viruses are reawakened, and the result is shingles. Only about 10 percent of those who have had chicken pox will develop shingles, however, and most people who develop the condition will have it only once.

Shingles is more likely to strike if you are more than 50 years old or if your immune system is compromised -- by age, stress, or medications that suppress the immune system. Patients whose immune systems are injured by chemotherapy, radiation, or other medical treatments are also at higher risk of developing shingles.

There may be no rash at first. The initial symptoms of shingles can be hard to diagnose and may include tingling, burning, itching, or even shooting pain. General flu-like symptoms, including fever and fatigue, may also occur. These symptoms can precede the outbreak of a rash by up to five days, but usually by no more than a couple of days. The rash first appears as red spots, which soon turn into painful blisters. The spots, which resemble chicken pox, will be distributed in the pattern of whatever nerves are affected. (More rarely, it can cause a generalized rash involving several nerves.)

It is believed that the name shingles comes from the Latin word, "cingulum," which means belt, because the shingles rash develops in a clearly defined belt or band in a limited area located on one side of the body. The rash can appear in any part of the body, including the head, and can also affect the eyes. (You should consult your doctor immediately if shingles appears anywhere on your head or face because it can sometimes cause irreversible hearing and vision problems; if a cornea is infected, it could even result in temporary or permanent blindness.)

In Italy, shingles is known as "St. Anthony's Fire," a testament to the pain that the affliction causes. Most people cannot wear clothing on the affected area, and the rash may be accompanied by general fatigue, achiness, a low-grade fever, and depression. The blisters burst and form scabs, which normally clear within several weeks, leaving pale scars.

If you haven't been vaccinated against chicken pox and have never had the childhood illness, you can develop chicken pox from having direct contact with someone who has shingles. However, you can't catch shingles from someone else, since it can only be caused by the chicken pox virus lying dormant in your own body (if you've had the childhood illness or vaccine). People with shingles should avoid direct physical contact with others who may not have had chicken pox -- or may not have been immunized against chicken pox in the past -- until all the blisters have scabbed over, at which time you are no longer contagious.

Although shingles causes pain and itching, it generally clears up in healthy people in a matter of weeks, with no lasting complications. The pain usually subsides along with the rash, but in some cases, especially in the elderly, discomfort persists for months or even years. This condition is known as post herpetic neuralgia (PHN).

Once the rash appears, its pattern and appearance almost always confirm the diagnosis, but a blood test or sample of fluid from the blisters can provide definitive proof.

In the largest adult study to date, the government-sponsored Shingles Prevention Study, researchers examined the effectiveness of a vaccine to prevent shingles in people over 60 years of age. The vaccination used for the 2005 study was a more potent version of the chicken pox vaccination now routinely given to children in the United States. Administered to nearly 40,000 men and women, the vaccine not only prevented about half of shingles cases, but also dramatically reduced pain severity and complications for those who got the disease. In 2006, the Centers for Disease Control began recommending the newly-licensed shingles vaccine, Zostavax, for people 60 and older.

Since shingles usually clears up on its own, you may not need treatment except for symptomatic relief. You may be treated for pain with analgesics, including over-the-counter products like ibuprofen, or stronger drugs if the pain is severe. In some cases, doctors also prescribe anti-inflammatory drugs for pain relief. Spreading calamine lotion or putting cool, wet compresses on the shingles can also help ease discomfort. Soothing body treatments such as cornstarch baths, colloidal oatmeal baths (available at drugstores), and mild lotions may also relieve the itching.

In addition, the affected area should be kept clean at all times to prevent bacterial infection. Clothing worn once should be washed in boiling water or otherwise disinfected before being worn again. Also, if the blisters are oozing, you may need to be isolated to prevent infecting others. Newborns and those with decreased immunity are at particular risk of contracting the virus from someone who has shingles.

There is no cure for shingles, but your doctor may prescribe antiviral medications to slow the spread of the virus in the nerve cells. People who are diagnosed early (within 72 hours of onset) are the best candidates to be treated with an antiviral medication because at this stage it can shorten healing time for the blisters and reduce the severity of pain.

Antiviral medications are also routinely prescribed in severe cases of shingles or when the eye is affected. Such treatment needs to begin within three days of getting the rash to be effective, so if you suspect you have shingles, see your doctor immediately.

If you do have the disease, you can generally expect relief after about three to four weeks -- unless you develop post herpetic neuralgia. PHN can be extremely painful and is often difficult to treat. For reasons that are not completely understood, some PHN patients get no relief from pain medication, and what works in one case may not be effective in another. Patients say the pain is often so intense that it makes doing even simple tasks impossible. Although many PHN patients experience isolation and depression as a result of the condition, most patients get better with time. Almost all are free of pain within one year.

Should PHN develop, there is a wide range of pain treatment that you and your doctor can choose from, including tricyclic antidepressants, anticonvulsants, opioids, and topical lidocaine patches, used either individually or in various combinations. Unfortunately, a process of trial and error is often needed to find the combination that works best, so keep working with your doctor until you find a pain treatment that works for you.

Experts hope that the chicken pox vaccine will eventually reduce the incidence of shingles and PHN, or even eliminate them completely. Since the Food and Drug Administration approved the vaccination in 1995, more than 60 percent of American children have been vaccinated. Experts say that the vaccination is 75 to 85 percent effective in preventing chicken pox, and completely effective in preventing severe cases of the disease.

It is likely that those who are immunized against chicken pox will still run some risk of getting shingles later on. However, that risk appears to be low. Research suggests that there is a lower incidence of shingles among vaccinated healthy people compared with people who have had natural chicken pox.

The vaccination is still very new, and we don't yet know how long it will remain effective -- the estimate is 20 years -- or if vaccinated individuals will again be susceptible to the disease once the vaccine wears off. However, the vaccine does look very promising.

-- Connie Matthiessen is a freelance health and medical writer in San Francisco who has written for Health, Hippocrates, Parenting, and many other publications.

References

First published September 20, 2004
Last updated November 9, 2007
Copyright © 2004 Consumer Health Interactive

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